Molecular landscape and site of metastasis in PDAC.

Authors

null

Shafia Rahman

The Ohio State University Comprehensive Cancer Center, Columbus, OH

Shafia Rahman , Yasmine Baca , Harshabad Singh , Joanne Xiu , Atrayee B Mallick , Mark P. Rubinstein , Andrew Aguirre , George W. Jr., Michael J. Pishvaian

Organizations

The Ohio State University Comprehensive Cancer Center, Columbus, OH, Caris Life Sciences, Phoenix, AZ, Dana-Farber Cancer Institute, Brookline, MA, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, The Ohio State University, Columbus, OH, Dana-Farber Cancer Institute, Boston, MA, Johns Hopkins University School of Medicine, Washington, DC

Research Funding

No funding sources reported

Background: More than 50% of patients with Pancreatic ductal adenocarcinoma (PDAC) have metastatic disease at the time of diagnosis and liver is the most common site of metastatic spread. Liver metastasis (LM) is associated with poor prognosis. Herein we examine the difference in molecular landscape of PDACs with LM versus other metastatic sites (OM). Methods: Total of 7,979 PDAC tumors underwent next-generation sequencing of DNA (592-gene/whole exome) and RNA (whole transcriptome) at Caris Life Sciences (Phoenix, AZ). Tumors were then evaluated and divided into LM (N=4988) site vs OM (N=3073) sites based on tissue specimen sites. RNA expression data was used to analyze transcriptional signatures as well as tumor immune microenvironment (TME) using Quantiseq. Real-world overall survival (rwOS) information was obtained from insurance claims data and calculated from time of collection or first treatment to last contact. Hazard ratio (HR) was calculated using Cox proportional hazards model, and P values were calculated using log-rank test.Significance for molecular comparisons was calculated using either chi-square, Fisher’s exact, or Mann-Whitney U test, with p-values adjusted for multiple comparisons (q<0.05). Results: Mutations in TP53 (81% vs 67%), KRAS (88% vs 83%), ARID1A (13% vs 11%), KDM6A (4% vs 3%), and BRCA1 (1.3% vs 0.7%) were all significantly higher in LM vs OM (all <0.05). Conversely, TMB-H (3% vs 4%), MSI-H (0.7% vs 1.3%), GNAS (1% vs 3%), STK11 (1% vs 3%), ATM (3% vs 5%), PTPRD (2% vs 9%) and RNF43 (5% vs 6%) mutations were significantly lower in LM vs OM (all q<0.05). In the TME, B cells, Tregs, M1, M2 macrophages, and NK cell infiltration was lower in LM vs OM (FC: 0.62-0.91, q<0.05). However, LM had higher neutrophil infiltration vs OM (FC: 1.1, q<0.05). Both interferon-gamma score (IFG) and T cell inflamed score (TIS) were significantly higher in OM vs LM (q<0.05). OM had better OS than LM (11.4 m vs 6.8 m, HR=0.65 95% CI: 0.62-0.68, p<0.001). This association held for tumors treated with Immune Checkpoint Inhibitors (ICI) (9.6 m vs 4.6 m, HR=0.71 95% CI: 0.52-0.97, p=0.031), Gemcitabine/Nab-paclitaxel treated (15.3 m vs 8.1 m, HR=0.57 95% CI: 0.52-0.61, p<0.001) as well as mFOLFIRINOX treated tumors (20.3 m vs 12.0 m, HR=0.57 95% CI: 0.52-0.63, p<0.001). Conclusions: When comparing pancreatic LM to OM sites, our data reinforces the observation that OS is better in OM vs LM and response to ICI was better in OM vs. LM. Significant differences were observed in molecular landscape, TME and signatures that are predictive of immunotherapy response (TIS and IFG scores).

TestPositive N in LMTotal N - LM% LMPositive N in OMTotal N - OM% OMq-value
TP53 mut3391419580.8%1631243067.1%0.0
GNAS mut4242141.0%8224513.4%0.0
KRAS mut3709421588.0%2048245683.4%0.0
STK11 mut5142111.2%7124482.9%0.0
PTPRD mut31432.1%8869.3%0.02
BRCA1 mut5641871.3%1724460.7%0.02
RNF43 mut19442174.6%14424565.9%0.04
ARID1A mut435339912.8%205191710.7%0.04

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Abstract Details

Meeting

2024 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer - Advanced/Metastatic Disease

Citation

J Clin Oncol 42, 2024 (suppl 16; abstr 4159)

DOI

10.1200/JCO.2024.42.16_suppl.4159

Abstract #

4159

Poster Bd #

139

Abstract Disclosures

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